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pp PERMIT
76A898A CEp809,9 6D APPLICATION FOR BUILDING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS
BUILDING AND SAFETY DIVISION LOCALITY
JOHN A. LAMBIE, COUNTY ENGINEER NEAREST
WILLIAM A. JENSEN SuP•T OF BUILDING CROSS ST.
DISJTt21CT N�" RTYPE / R C /Y
FOR APPLICANT TO FILL IN Io I I CONST.
BUILDING —.Ar - STATISTICAL CSIFICATION I S LB
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Q CLASS. NO. DWELL. UNITS
LOT NO. j BLOCK MAPNUMBER S�.WY YES O
TRACT ?J./ USE ZONE SPECIAL
T / CONDITIONS
NO.OF BLDGS.
SIZE OF LOT,P Sym NOW ON LOT
USE OF
EXISTING BLDG. ...+ i A♦'S BUILDING EXIST.
SETBACK YARD HWY STREET NAME WIDTH
OWNER L'I J� NO.TEL. FRONT
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P. L.
ADDRESS,5 O0s �.;. /,'C4,3yi Ci n ILs r SIDE
ARCHITECT OR TEL. -.� P.L.
ENGINEER C e O• " �� INSPECTION RECORD >..
ADDRESS Z /0 111 ,4 j W Cr iL
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CONTRACTOR /� e �1".S W TEL.
ADDRESS��G•
DESCRIPTION OF WORK 3 '�'`�' W
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1
6EW2 ADD ALTER REPAIR DEMOLISH • Z
O.FT. ,//.� NO.OF NO.OF
SIZE��!/' ITORIESS IAMILIES�ITORIESS IAMILIES� a r ,P
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USE OF - r _"' •�.f �.. /'��rr
STRUCTURE .L,,,. - .
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SIGNATURE OF
APPLICANT
VALUATION$ �C)'I
APPROVALS ATE INSPECT 'S SIGNATURE
/// FOUNDATION: LOCATION '"
FEE $ " I I FEE $ �' �" FORMS.MATERIALS "PMT. '+, Q. ' :� ✓� '? -+k
r FRAME: FIRE STOPS. ,u -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION BRACING, BOLTS
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY FURNACE: LOCATION.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS VENT DUCTS
BUILDING CONSTRUCTION. I CERTIFY THAT IN THE PERFORMANCE
OF THE WORK FOR WHICH THIS PERMIT IS ISSUED 1 SHALL NOT LATH, INT. z
EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBUECT
TO THE WORKMEN'S COMPENSATION LAWS OF CALIFORNIA.
LATH,EXT.
SIGNATURE O HOUSE NUMBER COR-
PERMITTE r RECT AND POSTED WOE `
ADDRESS FINAL
CLYDE N. DIRLAM, PRINCIPAL ST C RAL ENGINEER
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK� - M.O. CASH
U,l:o 3 4 1 6 :L c 1 G 3 0.0 0